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Can dysentery be asymptomatic? Treatment of dysentery in adults: effective medications and home recipes

Bacillary dysentery (shigellosis) is an infectious disease caused by the localization of pathogenic bacteria of the genus Shigella in the human intestine. The infectious agent is characterized by widespread distribution, which is facilitated by unsanitary conditions in large crowds of people. The infection is transmitted through the oral-fecal route. Symptoms of dysentery usually appear in acute form and are expressed by diarrhea, severe pain during bowel movements and general intoxication of the body. Antibacterial, rehydration and detoxification therapy is used to treat shigellosis.

The causative agent of dysentery is Shigella, a gram-negative bacillus, which includes four species - S. dysenteriae, S. flexneri, S. boydii, S. Sonnei. The most common is Shigella sonne.

Shigella is nonmotile and does not form spores, but is capable of long time save vital activity in the external environment under optimal conditions. In addition, bacteria are highly resistant to various antibiotics.

The incubation period of dysentery lasts on average 2-3 days, while most of the pathogenic bacteria die first in the stomach under the influence of secretory fluid, then in the intestine itself under the influence of beneficial microflora. The remaining microorganisms begin to colonize.

The first signs of dysentery appear from the beginning of the death of Shigella in the gastrointestinal tract. This is explained by contamination of the body with a number of toxins that are released by bacteria not only during vital activity, but also at the time of decay:

Endotoxins are a kind of cadaveric poison that is released when Shigella dies and causes general intoxication.
Enterotoxins - produced by living microorganisms to affect the cells of the mucous membrane. Their influence provokes the release of fluid into the intestinal lumen.
Cytotoxins - increase the penetration ability of bacteria into the cellular structures of the body by destroying their membranes.
Neurotoxins are a type of toxins characteristic only of Grigoriev-Shiga bacteria that can infect nervous system person.

Being in food, the causative agent of dysentery can retain its pathogenicity for quite a long time, but it can be neutralized by simple boiling or exposure to disinfectants.

Pathogenesis

During the incubation period of dysentery, the majority of pathogenic bacteria die. But still, a sufficient number of them reach the intestinal mucosa unharmed and begin the active process of reproduction. The immune system responds to the release of exotoxins into the blood of an infected person by producing neutrophils and macrophages, which destroy the structure of Shigella and absorb it.

As a result of the death of bacteria, endotoxin is released, which, together with the rest, causes the development of acute dysentery. The clinical picture is aggravated by the penetration of Shigella into large intestine, where their colonization of the mucous membrane is accompanied by severe inflammation, impaired motility and absorption capacity.

Sources of infection for dysentery can be several categories of infected people:

A patient with dysentery who is the main spreader of bacteria.
A recovering person who still has an infection in his body.
A bacteria carrier in which Shigella is constantly present in the gastrointestinal tract, without causing signs of dysentery.
A patient with a chronic form of the disease.

The main way to become infected with shingellosis is considered to be oral-fecal – bacteria excreted in excrement enter the gastrointestinal tract in a certain way. healthy person. But each species of Shigella also has its own distribution paths.

Dysentery pathogens can be transmitted in different ways:

Shigella Sonne is characterized by a food method in which the infection penetrates through poorly processed foods.
Flexner's dysentery develops when bacteria enter contaminated water.
Shigella Grigoriev-Shiga is characterized by contact and household ways of spreading dysentery, the symptoms of which are diagnosed less often in adults than in children.

Forms of dysentery

Depending on the type of pathogen and the stage of development, the disease takes on its own shape and has characteristic features.

Based on the clinical picture, bacterial dysentery is divided into several forms:

Spicy. The large intestine is mainly affected. Less commonly diagnosed are gastroenteric variants, in which the mucous membrane of the stomach and small intestine is affected. The development of pathology occurs quickly, within 24-48 hours. A severe form is fraught with complications, including fatal consequences. Mild cases usually go away spontaneously.
Chronic. This is a sluggish form or alternating with periods of remission and exacerbation. Moreover, the latter option can be characterized by both severe and erased signs. The chronic form is diagnosed if its manifestations do not go away after 3 months from the onset of infection.
Carriage. The balance of pathogenic and beneficial bacteria in the human body is determined by the constant struggle of these microorganisms. They do not cause harm to the owner, but they pose a certain danger to others.

Bacterial carriage is detected by chance during a routine examination. If, when repeating a stool test for the dysentery group, no infection is detected, the person is not considered a potentially dangerous source.

Acute dysentery is classified according to clinical signs:

Colitic – damage to the large intestine.
Gastroenteric – the infection settles mainly in the stomach and small intestine.
Gastroenterocolitic – almost the entire gastrointestinal tract is affected.

In addition, the classification of dysentery is carried out according to the severity of these symptoms, among which there are mild, moderate and severe symptoms of shigellosis.

Signs of infection

The forms of manifestation of dysentery depend on many components. These include not only the types of dysentery, but also the stages of development of this disease, which are characterized by the general condition of the patient.

Among them are:

Beginning of the disease. During this period, the first symptoms appear, which become increasingly worse over time.
Active phase. At this moment, all signs of the disease become more acute, the course takes on severe forms, and there is a risk of developing complications.
Phase of fading activity. Against the backdrop of drug exposure and an immune response, the manifestations of the disease subside, and the patient’s condition improves.
Recovery stage. During this period there are no signs of illness.

During the attenuation of symptoms, treatment should not be interrupted, even if it seems that the disease has completely receded. The course of therapy must be completed to exclude possible relapses.

The main symptoms of dysentery in adults and children:

Hyperthermia.
Intoxication.
Severe abdominal pain.
Loose stools.
Nausea, vomiting.
Dehydration.

For each form of dysentery and the stage of its development, the presence of certain symptoms is not always necessary, and their severity has different meanings.

Temperature indicators

The first sign of a severe form of the disease is sudden hyperthermia, in which the mark on the thermometer shows 40 degrees. In milder cases, its value reaches 37-38. For erased forms, such a reaction of the body may be absent.

An increase in body temperature indicates the beginning of the human defense system. As soon as Shigella penetrates the cellular structure of the stomach or intestinal mucosa, the immune system begins to produce white blood cells (neutrophils and macrophages) and send them to the bacterial colonies to fight. This action is accompanied by hyperthermia, the higher the rate of which, the more active this process is.

A patient’s fever can last from several hours to several days, depending on the severity of the infection and the strength of the immune system.

Manifestation of intoxication

Toxins in the patient’s blood appear as a result of the activity of infectious agents, the fight immune system, as well as the death of the bacteria themselves and opposing pyrogens.

The action of toxins affects the work of many internal organs and systems, involving them in pathological process. Severe dysentery in adults and children can manifest as impaired functioning of the autonomic nervous or cardiovascular systems.

Intoxication of the body during dysentery most often manifests itself:

Headache.
Weakness and lethargy.
Fatigue quickly.
Muscle pain.
Dizziness.
Loss of appetite.
Frequent heartbeat.
Mood swings.

Depending on the general health of the person indicated symptoms can manifest themselves in varying degrees of severity and be wavy in nature.

Painful sensations

The appearance of abdominal pain is typical for initial stage diseases. As a rule, they are cutting, pulling or cramping in nature, which depends on the location of the lesion. The pain may occur during the urge to defecate or be constant.

The presence of these symptoms is explained by the onset of development inflammatory processes in the gastrointestinal tract. Pain resembling contractions causes spasm of the smooth muscles of the intestines, resulting from impaired peristalsis. These sensations become aggravated in the active phase of dysentery and subside when a turning point occurs.

Quality of defecation

Stool disorder is the main clinical sign disease and can manifest itself in colitis and gastroenterocolitic forms. The gastroenteritis type is characterized by its normal state.

Severe diarrhea usually occurs at the initial stage of development of dysentery and is accompanied by copious bowel movements. As the disease progresses, the volume of stool decreases, but the amount of fluid in it increases. This is explained by the action of enterotoxin, which provokes its release into the intestinal lumen from the cellular structure of the mucosa.

At further development dysentery, thick mucus is observed in the patient’s excrement, which later almost completely replaces the feces. It is not uncommon to see blood or blood streaks. Their appearance is explained by damage to the colon, the presence of ulcers or purulent formations in it.

Dysentery is characterized by the occurrence of tenesmus - a false urge to defecate with nagging pain in the lower abdomen.

At mild form disease, the frequency of stools in a patient can reach up to 10, with moderate - up to 20, and with severe - up to 50 times a day.

Vomiting and dehydration

Antiperistalsis of the gastrointestinal tract (promotion of chyme in the opposite direction or vomiting) for dysentery is not one of the main symptoms. The development of vomiting is usually observed in the gastroenterocolitic form at the initial stage of its development, and occurs no more than 2-3 times.

Due to vomiting and constant diarrhea, the patient develops dehydration. In this case, you can most often observe:

Constant thirst.
Dry skin and mucous membranes.
Loss of skin elasticity.
Weight loss.
Decreased urine volume.
Weight loss.
Low blood pressure and rapid pulse.
Dizziness, impaired consciousness, coma.

If fluid loss reaches 9%, the patient may be diagnosed with severe dehydration, requiring immediate hospitalization.

The treatment of the patient depends on the severity of the symptoms of dysentery, the absence of which can lead to serious consequences.

Complications

Severe consequences of dysentery usually occur with improper or untimely treatment. The most serious complications are dehydration, prolapse or pathological dilatation of the rectum, extensive ulceration of the rectal mucosa, accompanied by bleeding, and sepsis.

Most often, a person who has had dysentery develops complications in the form of:

Disturbances of beneficial microflora, which gives impetus to the development of dysbacteriosis.
Exhaustion and general weakening of the body.
Decreased appetite and weight loss.

The chronic form of dysentery leads to inevitable changes in the structure of the intestinal epithelium and serious disruptions in digestive function. Before starting treatment for dysentery, the doctor must differentiate it from other types of infectious infections.

Diagnostics

To begin treatment, shigellosis must be confirmed. For this, signs and symptoms alone are not enough. Diagnosis of dysentery involves conducting certain types of examinations, which include:

Stool analysis.
General blood test.
Bacteriological culture.
Serological blood test.

For complicated forms of dysentery, sigmoidoscopy is prescribed. This procedure plays an important role in making a diagnosis and allows you to determine the presence of acute and fibro-necrotic inflammation, the stage of ulcerative formations and the process of their healing.

By using differential diagnosis It is possible to separate dysentery from other infectious groups, for example, salmonellosis, amoebiasis, escherisiosis and even cholera, which are often characterized by the same symptoms.

Treatment

The main recommendation for all types of this infection is immediate therapy. Treatment of dysentery in adults and children is aimed at suppressing the development of bacteria, destroying them, eliminating complications that have arisen and restoring normal functioning of the body.

Group of patients subject to mandatory hospitalization:

Patients who develop severe dysentery.
People with severe pathologies of vital organs.
Patients with dysentery, who are a potentially dangerous source of mass infection.

Therapy for mild forms can be carried out at home. The patient or his relatives must be explained what shigellosis is and what preventive measures must be taken to avoid becoming infected. In addition, you need to give detailed instructions what to do and how to treat dysentery at home.

Basic rules for home care:

Maintaining bed rest.
Reducing any loads.
Compliance with personal hygiene rules.
Use of separate utensils and household items.
Strict intake of medications prescribed for dysentery.

Drug effects

Drug therapy is the main direction in getting rid of the infection. Its effectiveness depends on the speed of measures taken and the correct medication.

The main drugs for the treatment of shigellosis:

Antibacterial agents, including such groups of drugs as nitrofurans (Enterofuril), fluoroquinolones (Ciprofloxacin), cholines (Chlorquinaldol).
Bacteriophages.
Detoxification solutions (Ringer's or Trisol).
Rehydration agents (Regidron).
Enterosorbents ( activated carbon, Enterosorb).
Probiotics and prebiotics (Bifidumbacterin).

Diet

Nutrition for dysentery should correspond to dietary table No. 4. His diet is aimed at restoring a weakened body and replenishing deficiencies useful substances. Dishes are prepared in a certain way to spare the injured gastrointestinal tract.

The diet for dysentery should contain small portions. The patient needs to drink up to 2 liters of water daily.

Fatty, fried, smoked, sweet and salty foods, any canned food and sausages, fermented milk products and alcohol are prohibited during the diet.

Preventive measures

Prevention of dysentery is aimed primarily at preventing the spread of infection. A sick person remains a source of infection throughout any stage of development of shigellosis. In addition, at the end of treatment, hypothetically healthy people must undergo a control test for dysentery. And only with a negative result can they be considered non-invasive.

It is almost impossible to acquire immunity to dysentery, especially since it is developed only against the type of bacteria that was found in humans and lasts only for 1 year. Logically speaking, it can be argued that the vaccine in the case of shigellosis is useless, since it is impossible to vaccinate against all types of bacteria that cause it.

Specific prevention of dysentery consists in imposing quarantine, thorough sanitization and regular inspection of places mass gathering people and catering.

Dysentery(or shigellosis) belongs to the group of acute intestinal infections - diseases with a fecal-oral transmission mechanism, which are characterized by symptoms of general intoxication and diarrhea.

The causative agent of dysentery is bacteria of the genus Shigella, which is why the disease itself is called “shigellosis”. The name “dysentery” is formed from two words of Greek origin – “dys” (disorder) and “enteron” (intestines).

Shigella is ubiquitous. Infection occurs through the fecal-oral mechanism - i.e. bacteria from the intestines of a sick person enter the gastrointestinal tract healthy person. This can happen through dirty hands, when bacteria get into food, water, or through insects. The infection is most widespread in developing countries, where overcrowding and unsanitary conditions contribute to this.

Shigella causes damage to the mucous membrane of the large intestine, which is manifested by loose stools with mucus and blood, and pain during defecation. However, many patients experience only mild watery diarrhea.

The causative agent of dysentery

The causative agent of shigellosis is a bacterium - a non-motile bacillus of the genus Shigella.

There are 4 types of this bacterium, each of which is capable of causing dysentery in humans: Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei.

A special feature of Shigella is its ability to quickly acquire resistance to antibacterial drugs. Bacteria resistant to traditional treatment. In addition, bacteria are extremely stable in the external environment - under favorable conditions they can retain their pathogenic properties for up to several months, including in food products.

Pathogenicity factors:

Shigella have a number of properties that make them pathogenic for humans, i.e. ability to cause disease.

Invasins are proteins that ensure invasion - the penetration of bacterial cells into the intestinal mucosa. Most often, bacteria affect the lower part of the large intestine.
Endotoxin is a toxin that is part of the bacterial cell itself. It causes signs of intoxication - fever, feeling of weakness, pain in muscles and joints.
An exotoxin is a toxin that is produced by bacteria and released into the blood. The most pathogenic toxin is Shigella dysenteriae serovar 1 (Shigella Grigoriev-Shiga), which is called Shiga toxin. Exotoxin is the cause of diarrhea.

How does dysentery become infected?

The mechanism of infection for dysentery is fecal-oral, i.e. bacteria from the intestines of a sick person enter the gastrointestinal tract of a healthy person.

There are several routes of transmission of the pathogen.

This is a contact and household route - through unwashed hands and failure to comply with personal hygiene rules; food – when bacteria get into food; and also water - when drinking infected water.

In addition, infection is possible by swimming in polluted waters.

Acute dysentery

The disease begins acutely – within 24-48 hours after infection. The most common type of infection is colitis – i.e. damage exclusively to the large intestine. However, sometimes gastroenterocolitic or gastroenteric variants occur - with damage to the mucous membrane of the stomach and small intestine.

Manifestations of acute dysentery:

Fever. The temperature rises to high levels. In children it can reach 40-41ºС.
Diarrhea. At the beginning of the disease, short-term watery diarrhea is sometimes observed, but then stools become more frequent up to 10-30 times a day and are released in small quantities. A large amount of mucus, blood, and sometimes pus appears in the stool. The admixture of blood in the stool is a distinctive sign of dysentery among all acute intestinal infections and indicates damage (ulceration) of the intestinal mucosa. The appearance of blood in the stool is a reason to immediately consult a doctor.
Cramping pain in the abdomen.
Tenesmus is a painful urge to defecate, as well as painful sensations in the anal area during and after defecation.

With gastroenterocolitic and gastroenteric variants of the disease, nausea, vomiting, and profuse watery stools may occur.

With a mild course of the disease, spontaneous recovery occurs within a week. In severe cases, serious complications can develop, and death is possible.

Chronic dysentery

Chronic dysentery is diagnosed if the disease lasts more than 3 months.

In this case, the course may be different.

There is either a continuous course of the disease, or a recurrent one, which is characterized by periodic exacerbations. In this case, periods of chronic dysentery alternate with periods of complete health. The severity of symptoms during relapse is usually much less than during acute dysentery. Signs of intoxication are much less pronounced - the temperature rarely exceeds 37.5ºС; stool is frequent, but the pain is not so painful, and there is usually no blood.

Bacterial carriage

Shigella carriage can be convalescent - if the bacteria continue to be released from the patient’s intestines after suffering from dysentery in the absence of any signs of the disease.

In addition, transient bacterial carriage is isolated, which is diagnosed by a single isolation of pathogenic Shigella from the stool of a healthy person who has not had dysentery. Most often this happens accidentally during a preventive examination and does not have any effect on human health.

Complications and consequences of dysentery

Dysentery is dangerous due to severe complications, both caused by intestinal and extraintestinal damage.

Rectal prolapse. Due to frequent painful stools and tenesmus, part of the rectum may fall out of the anus. Most often, the complication occurs in young children.
Dehydration. It is rare, more often with the gastroenteric variant of the disease, i.e. with copious watery stools.
Intestinal bleeding. With massive damage, extensive ulcerations of the intestinal mucosa, intestinal bleeding. Requires immediate hospitalization.
Toxic megacolon. A rare complication of dysentery. It is characterized by stretching of the lower part of the colon and thinning of its wall. As a result, toxins from bacteria in the intestines enter the blood in large quantities, leading to severe intoxication. Toxic megacolon is often fatal.
Hemolytic-uremic syndrome. Characterized by kidney damage with the development of severe renal failure, as well as hemolysis of erythrocytes - destruction of red blood cells with the development of severe anemia; In addition, there is a decrease in the number of platelets in the blood. Hemolytic-uremic syndrome usually develops towards the end of the first week of the disease, when the patient is already recovering. The first manifestation is a sharp decrease in the amount of urine - oliguria. In surviving patients, kidney damage continues to worsen and in 50% of cases leads to chronic renal failure requiring hemodialysis or kidney transplantation.
Bacteremia is the entry of bacteria into the blood of a sick person. It occurs mainly only in debilitated patients or those suffering from some type of immunodeficiency. Bacteremia is severe and often fatal.
Concomitant infections. Against the background of exhaustion with long-term dysentery, other infectious processes may occur. Most often it is pneumonia or urinary tract infection.
Post-dysentery intestinal dysfunction. Due to the fact that the infectious process affects the intestinal mucosa, often leading to serious damage, after recovery with a negative stool culture result, stool abnormalities may persist. Usually observed loose stool; it is not so painful, does not lead to significant negative consequences, however, it causes some discomfort.
Post-infectious asthenia syndrome. After suffering a severe infection, especially in young children, weakness, fatigue, and exhaustion may remain for several months. Dysbacteriosis. It occurs quite often after an infection. Usually effectively corrected with eubiotics.

Diagnosis of dysentery

If you have frequent stools mixed with blood, you should suspect dysentery. Moreover, due to widespread gastroenterocolitis variant of the disease, diagnosis of shigellosis is carried out with any frequent loose stools accompanied by signs of intoxication, i.e. as part of the diagnosis of acute intestinal infection.

Bacteriological research method. The most reliable method for diagnosing intestinal infections. It consists of stool culture to identify pathogenic bacteria.
Serological examination method. It consists of detecting antibodies to Shigella in the blood. However, this method is not used in everyday practice due to the availability, simplicity and reliability of the bacteriological method.
Polymerase chain reaction (PCR) - involves identifying Shigella genes in feces. PCR is an expensive examination method, therefore it is used extremely rarely for diagnosing acute intestinal infections.

Diet for dysentery

An important component of treatment is diet. If diarrhea persists, therapeutic diet No. 4 is recommended, which is characterized by a low content of fats and carbohydrates with a normal protein content and a sharp limitation of any irritants of the gastrointestinal tract. Also excluded are foods that can cause flatulence (increased formation of gases in the intestines).

wheat crackers, thinly sliced and lightly toasted.
soups with low-fat meat or fish broth with the addition of cereals: rice, semolina or egg flakes; as well as finely pureed boiled meat.
lean soft meat, poultry or boiled fish.
low-fat freshly prepared cottage cheese.
eggs no more than 2 per day in the form of soft-boiled or steamed omelet.
porridge with water: oatmeal, buckwheat, rice.
vegetables only boiled when added to soup.

Products to exclude:

bakery and flour products;
soups with vegetables, in a strong fatty broth;
fatty meat, pieces of meat, sausages;
fatty, salted fish, canned food;
whole milk and other dairy products;
hard-boiled eggs, scrambled eggs;
millet, barley, pearl barley porridge; pasta;
legumes;
raw vegetables, fruits, berries; as well as compotes, jam, honey and other sweets;
coffee and cocoa with milk, carbonated and cold drinks.

After stool normalization, you can switch to therapeutic diet No. 2. It is somewhat milder than diet No. 4. At the same time, the following is added to the diet:

day-old or dried bread. Non-food bakery products, cookies;
meat and fish can be cooked in pieces;
fermented milk products, including cheese;
eggs, other than hard-boiled eggs;
vegetables: potatoes, zucchini, cauliflower, carrots, beets, pumpkin;
ripe fruits and mashed berries;
creamy caramel, marmalade, marshmallows, marshmallows, jam, honey.

Treatment of dysentery

If there are signs of dehydration, take saline solutions: Regidron.
Sorbents are used to reduce the manifestations of diarrhea: Smecta, Enterosgel 3 times a day.
Taking loperamide (imodium) is contraindicated!!! Antidiarrheal drugs slow the release of the pathogen from the intestinal lumen, which can slow the course of the disease and worsen symptoms.
Antibiotics. In mild cases, the disease usually goes away without treatment. By the time the pathogen is isolated from the stool and its type is determined, improvement occurs and there is no need to take antibiotics. However, in severe cases, when diarrhea is accompanied by blood in the stool, tenesmus, and abdominal pain, antibiotics are indicated. The drug of choice in this case is ciprofloxacin 500 mg 2 times a day. However, ampicillin and tetracycline are also used. The duration of treatment is determined by the doctor, in standard cases it is 5 days.

How to avoid contracting dysentery

Prevention of Shigella infection comes down to following the rules of personal and communal hygiene:

Washing your hands before eating and after using the toilet.
Children younger age most susceptible to acute intestinal infections; Parents need to monitor their child’s behavior and teach the rules of personal hygiene from the very beginning. early age.
Compliance with food storage and preparation rules.
When caring for a patient, disinfection of bed linen and excrement is very important; it is necessary to wash your hands after contact with the patient.
Sick children should not attend kindergarten or school until negative stool culture results are obtained.
Food service workers should also return to work only after receiving a negative stool culture result.

Dysentery is an infectious intestinal disease, which in medicine is usually divided into amoebic and bacterial, that is, amebiasis and shigellosis. Amoeba was first identified by a Russian named Lesh (F.A), Shigella as the causative agent of dysentery - the Japanese Kiyoshi Shiga.

Since amebiasis is common in endemic countries with hot climates - Mexico, India, etc., in Russia this disease is quite rare. In order to recognize in time and begin adequate treatment of the disease, you should know what symptoms of dysentery may occur in children or adults.

In this article we will talk in more detail about shigellosis or infectious dysentery, the symptoms of which begin with general intoxication, vomiting, nausea, and belching. Dysentery is also manifested by heartburn, diarrhea and bloating, pain, false urge to defecate, rumbling (splashing noise), rectal spitting and raspberry jelly (damage to the distal parts).

However, only on the basis of patient complaints, it is impossible to establish the exact cause of indigestion and signs of intoxication. To establish a diagnosis, you must either submit stool for culture for the dysentery group or blood for serology (antibodies to Shigella).

Routes of infection, causes of dysentery in children and adults

The source of dysentery are persons suffering from chronic or acute forms of the disease, as well as bacteria carriers.

Patients with the acute form are most contagious in the first few days of illness. The acute form lasts about 3 months, during which bacterial excretion does not stop.
In chronic dysentery, a person can secrete Shigella only during exacerbations; the duration of such dysentery is more than 3 months.
The most unpredictable and dangerous bacteria carriers are people with an asymptomatic course of the disease, with erased or mild forms, when the disease is not pronounced, and the person secretes bacteria that cause dysentery.

The cause of dysentery in children and adults is failure to comply with personal hygiene rules and consumption of contaminated foods. The mechanism of infection with this infectious disease is only fecal-oral, which occurs in various ways:

The waterborne route of infection is most often transmitted by the so-called Flexner's dysentery.
Dietary route - Sonne dysentery is mainly transmitted by it
Contact-household way - Grigoriev-Shiga dysentery is transmitted.

All types of dysentery can be transmitted from person to person through household items if, if personal hygiene rules are not observed, they are contaminated with feces. Transmission factors for dysentery and other intestinal infections are water, flies, food, especially dairy products, unwashed fruits and vegetables, dirty hands, and household items used by a sick person.

Human susceptibility to dysentery is high

Moreover, it practically does not depend on age and gender, however, most often dysentery affects children preschool age, since they often do not have proper hygiene skills. The causes of dysentery in both children and adults may be not only the fact of infection itself, but also provoking factors, for example, susceptibility to intestinal diseases increases in the presence of chronic or acute diseases gastrointestinal tract, with ).

Seasonality of the disease

Like others intestinal infections, dysentery occurs more often in the warm season, in the autumn-summer, since favorable external conditions contribute to the activation and reproduction of the causative agent of the disease.

After suffering from dysentery, a person retains immunity for a year, which is strictly species-specific.

The causative agent of the disease can remain active in the external environment for up to 1.5 months, and when it gets on some products, especially dairy products, it can multiply. The occurrence of dysentery begins after the penetration of Shigella into the gastrointestinal tract, then multiplying, the pathogen releases poisons into the blood; these toxins negatively affect the blood vessels, liver, blood circulation, intestinal walls and the central nervous system. Inflammation that occurs in the lining of the small intestine can lead to the formation of deep ulcers in the intestines.

Symptoms of dysentery in children and adults

In establishing the diagnosis of the disease, data on the presence of an outbreak of dysentery, registration of cases of the disease among the patient’s environment, and seasonality are important. The incubation period for this intestinal infection is considered from several hours to 5 days, but most often it is 2-3 days, so the possible source of infection can be determined with high accuracy. What are the hallmarks of dysentery? Symptoms in adults with a typical clinical picture of dysentery are as follows:

Dysentery begins acutely, and the symptoms primarily show signs of intoxication of the body, high temperature, headache, nausea, loss of appetite, fall blood pressure.

The pain in the abdominal area is dull, at first it is constant and diffuse. As intoxication develops, it takes on the character of attacks and becomes cramping, often on the left side of the lower abdomen or above the pubis. Before bowel movement, the pain intensifies.

Dysentery is characterized by the appearance of tenesmus, that is, a false painful urge to defecate that does not end with defecation. There may also be pain in the rectum during bowel movements and for several minutes after bowel movement, nagging pain in the intestines can spread to the sacrum.

Stools become more frequent, more than 10 times a day, and mucous-bloody discharge often appears; in severe cases, only bloody mucous discharge appears during bowel movements.

There is also a gastroenteric variant of the disease (no more than 20% of cases). For him, fever and intoxication do not precede intestinal disorders, but coincide in time with them. This form debuts immediately with vomiting and loose, watery stools. From the second or third day, colitis may also develop. This form is very characterized by dehydration (unlike colitic), there is lethargy, a drop in blood pressure, dry mucous membranes and skin, and a decrease in urine output.

The disease occurs in various forms, from mild malaise, discomfort in the intestines and low-grade fever, to a serious, severe course of dysentery, the symptoms and treatment of which require urgent hospitalization of the patient - complete refusal of food, feverish condition, pallor of the skin, frequent bowel movements, vomiting, neurological disorders.

In chronic dysentery, the symptoms of the disease are no longer intoxicating in nature, but constant daily diarrhea persists, stool most often has a greenish tint and is mushy, the person loses weight, and hypovitaminosis appears. With timely and adequate treatment developed countries Cases of chronic dysentery are practically not recorded, since the use of antibiotics, enterosorbents, and eubiotics, of which there are a great many in the modern pharmacological industry, successfully suppress the proliferation of Shigella.

Features of dysentery, symptoms in children

Dysentery in young children has a number of features. The main clinical manifestations are diarrhea with colitic syndrome (small amount of feces, the appearance of blood, mucus in the stool) and symptoms of general intoxication, which are no different from most infectious diseases- deterioration in health, elevated temperature, loss of appetite. Colitic syndrome occurs in 90% of cases, but its manifestations may not be clearly expressed, but only combined with dyspepsia syndrome.

On the first day of illness, due to the spastic condition of the intestines, the child’s stool becomes scanty; instead of feces, only cloudy mucus with greens, sometimes streaked with blood, can be released.

Tenesmus, which occurs in older children and adults, in young children is replaced by crying during bowel movements, anxiety, and relaxation anus. Unlike older children, in infants and children under 3 years of age the abdomen is usually not retracted, but swollen.

Toxic forms of dysentery occur very rarely in infants. Their infectious toxicosis is mild due to physiological hyporeactivity to microbial toxicosis. But exicosis (dehydration) is very typical for them, which develops quite quickly with vomiting and diarrhea.

Symptoms of dysentery in children are manifested by frequent, profuse, watery stools, vomiting, and sudden weight loss, as severe disturbances of water-mineral and protein metabolism occur. Such changes can lead to cardiovascular disorders, adynamia, intestinal paresis and other serious complications.

In infants, symptoms are supplemented by the occurrence of ileocolitis, ileitis with fever, severe intoxication, constant vomiting, significant loss of body weight, flatulence, copious, frequent, cloudy, foul-smelling stools. It has been established that such forms of dysentery are usually combined with staphylococcal infection.

The most severe symptoms of dysentery intoxication in children are considered to be convulsions, cyanosis, cold extremities, and children may also experience tachycardia, cardiovascular weakness, arrhythmia, drop in blood pressure, muffled or deaf heart sounds.

How do the symptoms of dysentery differ from other intestinal disorders?

Dysentery should be differentiated from various other intestinal infections or non-infectious intestinal diseases, such as:

For toxic food infections, salmonellosis

These diseases begin with repeated vomiting, chills, pain, which is most often localized in the epigastric region. At food poisoning There is no damage to the colon and therefore there is no spastic pain on the left in the iliac region, and there is also no false urge to defecate. With salmonellosis, the stool has a greenish tint or, as they say, the appearance of swamp mud.

Amoebiasis

Unlike infectious dysentery, it is characterized by a chronic process without a noticeable temperature reaction. Feces retain the appearance of feces, while mucus and blood mix evenly, forming “raspberry jelly”, in which amoebas, the causative agents of the disease, are found.

Cholera

also not accompanied by symptoms of spastic colitis. This disease begins with diarrhea, severe vomiting, stool looks like rice water, there is no high fever, abdominal pain or false urge to defecate. Cholera is characterized by rapidly increasing symptoms of dehydration, which often leads to a serious condition for the patient.

Typhoid fever

also not typical for him spastic colitis, sometimes the colon is affected, there is a high temperature for a long time, a specific roseola rash.

Colitis

non-infectious origin, occurs during poisoning chemical compounds, and it often accompanies diseases such as hypoacid gastritis, cholecystitis, uremia, and pathology of the small intestine. This type of colitis has no seasonality, is not a contagious disease and is associated with internal changes in the gastrointestinal tract.

This disease is characterized by bloody discharge, but usually without inflammatory processes in the colon. With hemorrhoids, only at the end of the act of defecation does blood mix into the stool.

Colon cancer

This disease is also characterized by diarrhea with blood and symptoms of intoxication in the stage of tumor disintegration. However, oncological diseases do not have an acute course and are characterized by the presence of metastases in distant organs or regional lymph nodes.

Treatment of dysentery

Children diagnosed with dysentery, especially infants and young children under 3 years of age, are most often hospitalized. Adult patients can be treated both in a hospital and at home, depending on the severity infectious process, age and condition of the patient, or if it is impossible to treat and care for the patient at home. The main treatment consists of prescribing the following drugs:

When choosing antimicrobial agents: mild forms are treated with furazolidone, moderate and severe forms are preferable to fluoroquinolones or cephalosporins, aminoglycosides (kanamycin).
From the first days of illness, children should be given saline, glucose-salt solutions - Regidron, Oralit, Glucosolan, etc. 1 sachet of such products should be diluted in 1 liter of water, given to the child a teaspoon every 5 minutes, based on a daily dose of 110 ml per 1 kg. child.
Adsorbents, enterosorbents -, Polyphepan, ), activated carbon, etc.
Enzyme complex preparations - Festal, Creon, Panzinorm, Mezim.
In chronic dysentery, treatment with antibiotics is less effective, so physiotherapeutic treatment, eubiotics, and therapeutic microenemas are prescribed.
A gentle diet - mucous soups, rice water or porridge without salt, mashed potatoes. It is not worth force-feeding either a child or an adult, the main condition is more liquid, you can drink unsweetened, weak tea, water, whey. Exclude from the diet baked goods, meat, sugar, coffee, all semi-finished products, ready-made products, smoked meats, sausages, cheeses, etc. Only from the 5th day can you gradually add boiled fish, meatballs, omelettes, kefir. After 2 weeks, transfer to a full-fledged, but dietary diet.

Dysentery is a general infectious disease caused by dysentery bacteria. Most often the development of the disease is provoked by shigella . Amoebic dysentery manifests itself as a consequence of infection gnostolytic amoeba . With the development of this disease in humans, the mucous membrane of the large intestine is mainly affected.

Dysentery is most often diagnosed in children aged two to seven years. But the disease can affect people from any age group. Less commonly, signs of dysentery are recorded in infants, since in the first months the child has a strong dysentery inherited from his mother. As a rule, the disease can develop in infants if the water or food contains the causative agent of dysentery.

Symptoms of dysentery mainly appear in the summer. The infection spreads quickly, and if basic hygiene rules are not followed, the child may need treatment for dysentery. That is why disease prevention consists, first of all, in strict adherence to general hygiene standards.

Amoebic dysentery

Amoebic dysentery (amoebiasis ) is caused by a gnostolytic amoeba. Infection occurs when mature cysts of the Histolithic amoeba enter the gastrointestinal tract through the mouth. A person can become infected if they drink raw water that has been contaminated, as well as by consuming foods contaminated with the pathogen. Most often this disease is diagnosed in areas where the climate is very hot.

With this form of dysentery, the incubation period can last up to 30 days. There are three forms of the disease: extraintestinal , intestinal , cutaneous amoebiasis . Intestinal amoebiasis is the most common. In turn, this form is divided into amoebic colitis And amoebic dysentery . With amoebic colitis, a person’s appetite decreases, abdominal bloating appears, and constantly alternate constipation And diarrhea . After defecation, the patient constantly experiences the feeling that the intestines have not been completely emptied. The stool has a mushy consistency and contains mucus. Sometimes blood may also be found. The temperature in an acute condition increases slightly and for a short period.

With amoebic dysentery, patients note severe aching or cramping pain, loose stools with blood and mucus, general weakness and malaise. Stool can appear up to 10 times a day. A moderately elevated body temperature persists for 3 to 5 days. There is also bloating and a coating on the tongue. Sometimes doctors also note an enlarged liver.

With both types of amebiasis, a person’s ability to work is reduced, anemia, bad dream. During a rectal examination, ulcers in the distal colon and mucosal ulcers are detected.

With extraintestinal amebiasis, the liver is most often affected, and amoebic hepatitis develops. Cutaneous amebiasis develops, as a rule, with the intestinal form.

As complications of amebiasis, pericolitis, intestinal, intestinal obstruction, lung abscesses, and subdiaphragmatic abscesses can develop.

The diagnosis is made based on epidemiological data. The doctor studies the medical history in detail and examines the patient. Also an informative method of research is sigmoidoscopy and parasntoscopic examination of the patient’s stool.

Treatment of amoebic dysentery involves compliance with diets , the use of pathogenetic and symptomatic drugs. Also, if necessary, patients are prescribed antihistamines, vitamins.

How is dysentery transmitted?

The causative agents of the disease are in the form of rods. They die instantly at a temperature of 100C; at a temperature of 60C they can survive for about half an hour. The pathogen dies in the stool within a few hours.

The infection spreads from patients with acute and chronic forms of the disease. Infection is also possible from bacteria excretors, which are people with a mild course of the disease. Such patients do not consult a doctor due to the mildness of their symptoms. The infection can be transmitted through food and drink, and it can also be spread by flies. Transmission of the pathogen can also occur through dirty hands.

Symptoms of dysentery

There are two forms of dysentery - acute And chronic . In the acute form of the disease, a person can be sick from 3-4 days to three months. If the disease continues longer, then we are talking about a chronic form of dysentery. The duration in both cases can vary from 18 hours to 5 days.

If the patient has a moderate course of the disease, then its symptoms are more acute. Initially, a person feels weak and unwell, and may shiver a little. Later, cramping pain appears in the left side of the lower abdomen. The stool is liquid, with blood and mucus, its frequency sometimes reaches 25 times a day. In the first two days of dysentery development, the frequency of stool increases. In addition, the patient's body temperature rises, which can reach 39 degrees, and he is bothered by a headache. The temperature subsides after 2-5 days.

For most patients, abdominal pain does not subside for a long time. Sometimes the pain does not subside even for a while. As a rule, the stomach hurts in the lower left part, but some patients note that the pain is diffuse. Often also noted. In severe forms of acute dysentery, the onset of the disease is always violent. The patient is very worried severe pain in the lower abdomen, having a cramping character. The stool is loose and very frequent, vomiting, nausea may occur, and the body temperature rapidly rises. IN stool in addition to mucus and blood, pus may be detected. The patient's pulse quickens, blood pressure decreases, and... Severe dysentery can last up to 6 weeks. If the disease is not adequately treated, it can become chronic.

A child with dysentery immediately has abundant stool, but then its appearance changes, lumps of gray-green mucus appear in it. At this time, the child’s body becomes very dehydrated. If the baby has dry mucous membranes, then we're talking about already about a significant loss of fluid. Parents should also be aware of the fact that dehydration is more dangerous the younger the child.

In severe cases of dysentery, the baby may develop cardiovascular failure , appear convulsions ,consciousness is impaired . In this case, urgent hospitalization is important.

A sick baby with dysentery has cold limbs and constantly regurgitates. Sleep is very restless and bad.

Diagnosis of dysentery

To diagnose dysentery in a patient, bacteriological culture of stool is performed in the laboratory. To ensure the accuracy of the research result, the analysis is carried out three times. However, this method is not always suitable for diagnosis, since results appear only after a week. In order to speed up the diagnosis of dysentery, detection of the causative agent of the disease and toxins in the blood and feces is practiced.

In this case, immunological methods are used. To determine the presence of Shigella, the polymerase chain reaction method is used.

In the process of establishing a diagnosis, the patient also undergoes a stool analysis (coprogram). If the test material contains a large amount of mucus and at the same time an increased number of leukocytes and red blood cells are present, then the integrity of the intestinal mucosa is most likely compromised.

Treatment of dysentery

In the process of treating dysentery, the most important point is the destruction of the causative agents of the disease. It is also necessary to restore normal water-salt balance and ensure detoxification of the body. If the disease is severe, the patient is treated in a hospital. Light shape dysentery can be treated on an outpatient basis.

Effectively fights Shigella medications belonging to nitrofuran series , and also quinolines , fluoroquinolones . Prescribing antibacterial medicines, the doctor is necessarily guided by the characteristics of a particular case. After all, it is important to take into account the sensitivity of the Shigella species to the specific drug prescribed. The patient takes antibacterial drugs for 3-4 days if he is diagnosed with a moderate form of the disease. If we are talking about a severe form of the disease, then antibacterial agents are appointed for 5 days.

During this period, the patient gradually improves general condition body, the temperature returns to normal, the nature and frequency of stools also normalize. After the course antibacterial therapy ends, for several days the patient still experiences mild intestinal dysfunction. The stool remains liquid, its frequency is no more than three times a day. But at this time there is no longer any need to take antibiotics.

If a patient is diagnosed with a mild degree of the disease, then he is advised to drink plenty of fluids. The fact is that in the process of vomiting and diarrhea, the body loses fluid and salts. The most optimal drink would be water with the addition of soda, salt and sugar. You can also add to water special drug rehydron . You need to drink in small portions and often. In severely ill patients, special solutions are administered intravenously in order to restore the water-salt balance.

In order to remove toxins from the body when treating dysentery, a course of treatment with enzyme preparations is prescribed. Patients take calcium supplements . In addition, enterosorbents are used for treatment: activated carbon , enterosorb , . They help remove toxins from the patient's intestines. The course of treatment also includes high doses vitamins

If there is a need to relieve a severe pain attack, then other drugs that relieve spasms are used for this purpose.

When treating this disease, the correct approach to nutrition is important. You should not eat foods that enhance fermentation processes in the intestines. These are milk, legumes, black bread, cucumbers, beets, cabbage.

When treating children, special attention must be paid to nutrition. If a child categorically refuses to eat, then force-feeding him is not recommended. During the period when the child feels better and has an appetite, it is advisable to reduce the amount of food by half and increase it gradually. This will prevent overloading the recovering baby’s body. But the child should drink as much as possible. Compotes and fruit drinks are ideal for this.

Some are also practiced traditional methods treatment of dysentery. However, they can only be used after the approval of the attending physician. You can prepare an infusion of oak bark, a decoction of honeysuckle flowers, an infusion of yarrow flowers. An effective remedy To treat dysentery, burnet root is used, from which an infusion is also prepared. Also used are decoctions and infusions of plantain herb, the fruits of bird cherry, blueberry, and blackberry leaves.

Doctors

Medicines

To prevent the disease, it is very important to comply with all sanitary and hygienic standards. In order to prevent mass infection of the population, strict sanitary supervision is carried out over enterprises that produce food products and provide public catering. It is equally important to control the water supply. All these measures are aimed at preventing the massive spread of intestinal infections.

Personal prevention measures include, first of all, regular and thorough hand washing. In addition, it is important to promptly get rid of flies indoors and prevent them from coming into contact with food. Parents should make every effort to protect their child from infection by pathogens. You should not only ensure that the child washes his hands after using the toilet and walking, but also avoid eating unwashed fruits and vegetables.

Diet, nutrition for dysentery

List of sources

Shuvalova E.P. " Infectious diseases" - M.: Medicine. - 2001;
Pokrovsky, V.I. Bacterial dysentery / V.I. Pokrovsky, N.D. Yushchuk. - M.: Medicine, 1994;
Shakhmardanov M.Z., Luchshev V.I., Kornilova I.I., Sokolova L.V., Onukhova M.P. Flexner's shigellosis (clinic, diagnosis, treatment). Methodical recommendations Ministry of Health of the Russian Federation. M: Publishing house "Hermes-MTK". 2000;
Yushchuk N. D., Brodov L. E. Acute intestinal infections: diagnosis and treatment. - M., 2001.